In the United States, 1 in 9 babies is born prematurely, 1 in 10 in Canada. Worldwide, over 15 million babies are born too soon each year. While not all multiples are born prematurely, a multiple birth increases the probability of an early delivery. Babies born prematurely, before 37 weeks gestation, are at a higher risk for health complications in infancy, some of which can have long-term effects. Full-term infants are not all free from their own health complications, of course.
In honor of November’s Prematurity Awareness Month, led by the March of Dimes, How Do You Do It? is focusing this week’s posts on The Moms’ experiences with premature deliveries, NICU stays, health complications, special needs, and how we’ve dealt with these complex issues.
Once J and M were born at 33 weeks gestational age, they were whisked off to the NICU. I have to admit that my memories are fuzzy and I wasn’t there for the first day and a half, having just undergone a C-section. In this post, I’ll describe my impressions of our 3-week residency of the NICU. I’m not referencing medical records for this post. This is all mommy memory.
On the Outside
I’d run a fever after the C-section, so I wasn’t allowed to visit the NICU. Even after the fever abated, I was told, I’d have to wait 24 hours before I was cleared to visit the NICU. I had a major meltdown when a nurse had implied that the drops of colostrum I’d finally managed to pump weren’t worth transporting to the NICU. After all, pumping was the only maternal duty I could perform. I was a crying wreck and found myself starting to feel increasingly distant from the whole situation, as if I were watching everything from 3 feet above my body, as if the birth had never happened.
I’d asked my husband and in-laws to watch me for signs of postpartum depression, and my mother-in-law gently, but firmly, pressed my phone into my hand and told me to call my therapist. We had a session over the phone. I poured my heart out: the feelings of failure and powerlessness surrounding the preterm birth experience; the fear that I would never have truly maternal feelings toward these still theoretical children; the greater fear that M would die; the surreal fear that I would enter the NICU and have no idea which children were mine; the practical concern that I would exhaust my maternity leave before my children ever came home; the jealousy I felt toward my husband and mother-in-law for being allowed to see the babies. My therapist–the same one who had walked me through my past toward peace, even excitement, about being a mother–validated my feelings, helped me feel that they were normal and transient. She grounded me.
My NICU story started well before I ever entered the NICU.
My husband knew that I needed to see the children, for their well-being and mine. He refused to take no for an answer and finally found someone to permit me to see my children as long as I wore a surgical mask in the NICU. I balked, fearing that my needs would endanger our children. He insisted and I was too broken to press my point.
I transferred from the bed to a wheelchair, which did not feel good a day after I had been cut open, my womb cleaned out, and then sewn back together. My organs were still finding their places around my much reduced womb. I was wheeled into the NICU and had to stand (OUCH) to scrub in. I felt another twinge of jealousy as my husband scrubbed expertly up to his elbows and under his nails while I tried to follow the directions on the wall. I had no idea that the smell of that soap would return me to these memories every time I encountered it again.
I first saw my girls when they were 36ish hours old. I’d seen Polaroid images of each of them, as well as photos on my friend’s phone, but I wasn’t prepared for how truly tiny they were or all the wires and tubes and machinery. The beeps and dings and whirs coming from all around the room were overwhelming. I was deeply thankful for the name tags; I wouldn’t have been able to identify my daughters without them.
My husband explained to me what each sensor did, but nothing stuck. A nurse asked me if I wanted to hold the girls. It hadn’t occurred to me that I’d be allowed to, so I just stuttered. I honestly didn’t remember which child I held first until I looked back at my photos just now. My second born M was the first in my arms.
I remembered to be surprised that weren’t placed in the same open warmer. I remembered reading that multiples do better in the NICU if they’re allowed contact with each other. The hospital had recently changed their policy, I was told, and no longer co-bedded multiples. I was annoyed.
In the NICU
It took no time at all for us to get into a routine. Apart from a period several times a day when doctors did their rounds, parents could stay in the NICU at their child’s side. My husband and I were each given wrist bands that permitted us entry into the secure facility. We could each bring a maximum of one visitor at a time to visit the girls, since technically we could have two visitors per child.
Every three hours, our children were tended by the nurses, first M then J. Their diapers were changed and weighed. We were allowed to help with that. The babies were weighed twice a day. They were fed a mixture of high calorie formula and whatever milk I could produce, by a tube threaded through their noses into their stomachs. My husband gavage fed them, but I never learned how. Neither of us was keen on pricking their feet to gather a blood sample; we left that task to the nurses. We took their temperatures, though. The NICU nurses sent us home with their individual thermometers. I used those things until they were over 4 years old.
We considered taking advantage of the nearby Ronald MacDonald House, which allowed parents of sick children to stay near the hospital. We only lived 30 miles away, though, it seemed wrong for us to take a spot that could be better used by parents who lived farther. The maternity ward was kind enough to let me stay in my room, left to my own devices for food, of course, for several days after I was officially medically released.
I ripped out my staples a couple of times walking down the hall to the NICU, but no one and no pain was going to keep me from my kids.
On the second or third day after birth, our nurse encouraged us to provide kangaroo care to our girls. My husband unbuttoned his shirt, leaned back in his chair, unwrapped J from her swaddle and buttoned her snugly against him, chest-to-chest. I pulled open my tank top and did the same with M. She wiggled herself into a comfortable position and fell asleep. J had other ideas. She squirmed and wriggled and twisted until she’d pulled herself up Daddy’s chest and was nestled under his chin. We sat like that for hours until it was time for their heelpricks and feedings. I knew that I was serving the same purpose as the open warmer, one of the purposes I’d served during my pregnancy, keeping little M warm. I felt like her mom for the first time, and it was great to share that feeling of growing a human with my husband. He kept poking me to ask whether I’d seen his rock star of a precocious preemie climb up him. Had I really seen it? That was his girl. My husband was as proud of J in that moment as he was at the only one of her ballet recitals he was able to attend, 5 years later.
When our girls were a few days old, I was telling my nurse Michelle how surprised I’d been by their cobedding policy. She asked if I had any photos of the two of them together and was shocked when I said no. She looked around furtively and then grabbed the camera while my husband held one baby and I held the other, surreptitiously and briefly reunited. M had just pulled her feeding tube out again.
A few days later, both our girls were moved from open warmers to closed isolettes. I could no longer sit between them and place a hand on each of my daughters. A few days further along, we were given a private room within the NICU, just for our pair, away from the sounds of the machines monitoring the much sicker babies.
We were told that our babies were feeder-growers. There wasn’t anything functionally wrong with them that couldn’t be attributed to their small size. They simply needed to feed and grow. There were four criteria to be met so we could take them home. They needed to be able to take at least 31 mL (1 oz) of nutrition by mouth 8 meals in a row. They needed to weigh 5 lbs. They needed to be able to maintain their body temperature without a warmer or kangaroo care. They needed to pass the car seat test.
We had a constant reminder of how fortunate we were. There was a little boy across the NICU aisle from our girls, a 4-month-old. He would never leave the NICU alive. The alarms that indicated dangerously low vitals went off several times a day. His parents couldn’t even visit daily any more. They’d had to return to work. I thought about the little boy on hospice care often, even after the girls were home.
Once bottles were introduced to my daughters, somewhere before the one-week mark, M was a drinking pro. J was tougher to feed. She’d get distracted, toying with the nipple in her mouth instead of suckling. I was only allowed to breastfeed M, and that, only once. My milk had already come in; I was a slave to the breastpump. A lactation consultant came to the NICU and helped me work on my latch. I couldn’t believe she expected my entire areola to fit in her mouth; my breast was twice the size of her head! (It didn’t fit, in case you were wondering. Not completely.) Let down was so beautiful, not the mechanical and slightly painful mechanical action of the pump. Just as I felt like M and I had it down, it was time for me to learn how to break the latch with my comparatively enormous pinkie. Nursing was using too many of the calories that needed to go to growth.
At one point, after several days of oral feedings, J had to have her feeding tube reinserted. She just wasn’t getting enough calories orally. It was the first time during the entire ordeal that I saw my husband cry. The NICU was all two steps forward, one step back. They’d gain weight and then stall. They’d stay warm, then begin to run cold again. J would feed orally, then forget. And we had it easy: no apnea, no bradycardia, no jaundice. The other babies in the NICU were always there to remind us how much worse it could be.
We’d been told not to expect the girls home before their due date. That would leave me only 4 weeks of maternity leave to establish our routine before I had to go back to work. I began to talk about going back to work as soon as my doctor released me so I could maximize my time at home. A nurse took me aside and told me not to go down that road. The girls were doing so well that they’d be home long before they reached 40 weeks gestational age.
At one point, the hospital staff asked if they could transfer J and M to a lower level NICU at a different hospital closer to our home, freeing up beds for sicker kids. We were all for it until it was time to sign a waiver excusing everyone of responsibility for our kids during transport. We refused to sign; we saw another family signing the paperwork a few hours later.
At one point, my husband noticed that all the neonates had Spanish last names “except the twins;” there was another set there. I pointed out that our last name was Rodriguez. Even though he didn’t consider himself Hispanic and I was South Asian, our family still fell in the Hispanic camp. We asked the nurses about it, and they said that they thought the demographics of the NICU were connected to the availability of prenatal care in the poorer Hispanic population of South Austin.
When the girls were almost 2 weeks old, we got the news. They were out of the woods. We were just waiting for them to achieve the magical 5 lb weight so they could go home. My husband told his commander in the army. He was immediately ordered to California for pre-deployment desert training. They could spare him for the 14 days of his paternity leave, but if our kids were out danger, that was all he got. His mom drove him to the airport. I stayed at the hospital with our babies.
One Baby Home
When M was 16 days old, my father-in-law drove us home from the NICU. I didn’t expect her to be released with such little fanfare. I had no idea she was doing so well. I was still recovering from my C-section and wasn’t cleared to drive. We left J all alone. I didn’t know whether to celebrate or grieve. I felt horrible leaving J, regardless of how much I trusted the nurses. I thought that the birth experience had ripped my heart out, but I now felt true agony.
On arriving home, I immediately began to breastfeed M, supplementing her feedings twice daily with high calorie formula from a bottle. Every drop I pumped, I delivered to the NICU for J once a day. I couldn’t spend more than 10 minutes with her; little M was waiting in the parking garage with Grampy, since non-patient children weren’t allowed in the NICU.
I tried to be positive. I figured M was missing J more than I possibly could.
After the 5 longest days of my life, J took 8 31-mL feedings in a row. She was allowed to come home. Both kids were doing so well that the hospital waived the 5-lb requirement to free up beds in the NICU. Daddy came home from California about 3 weeks later. Until his deployment another 3 months from then, our family was complete.
As soon as I placed the babies side by side, before Daddy got to come home, they stretched and rooted and wriggled and wiggled until they were pressed up against each other. Each raised one hand above her head, firmly grasped her sister’s hair, and fell asleep. At age 7, they still sleep snuggled up like that, minus the hair pulling, unless they’ve been arguing. J prefers to sleep on her belly, M on her side, but I insisted they stay on their back as newborns for fear of SIDS.
Our NICU story was over, but I was painfully aware that all but one or two of the babies who were in the NICU the day my girls were born were still there. They had a much rockier road ahead than my tiny pair.
Sadia (rhymes with Nadia) has been coordinating How Do You Do It? since late 2012. She is the divorced mother of 7-year-old monozygotic twins, M and J. She lives with them and their 3 cats in the Austin, TX suburbs and works full time as a business analyst. She retired her personal blog, Double the Fun, when the girls entered elementary school and also blogs at Adoption.com and Multicultural Mothering.